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What is a Lisfranc Injury?
A Lisfranc joint injury involves a type of injury to the bones and/or ligaments, in the central area of the foot. In a Lisfranc joint injury, the cartilage covering these bones usually suffers damage. In the middle region of the foot (midfoot), a cluster of small bones form an arch. Damaging these delicate bones via an intense sprain or other injury can create a lisfranc fracture.
What is a Lisfranc Fracture?
A LisFranc Fracture or Lisfranc Injury describes an injury that involves the medial cuneiform or second metatarsal and ruptures the Lisfranc ligament, which binds the medial cuneiform bone and the second metatarsal bone together.
The fracture can involve more than one metatarsal bone, and can occur due to a variety of incidents that can include sports injuries, motor vehicle accidents, or simple missteps.
What are the symptoms of a Lisfranc Fracture?
As a fracture in a sensitive and weight bearing area of the foot, symptoms of a Lisfranc Fracture can include:
- Foot Pain
- Foot instability
How does a Foot and Ankle Specialist diagnose a Lisfranc Fracture?
A foot and ankle specialist will take a detailed medical history of the patient and perform a physical exam prior to requesting diagnostic imaging. The initial consultation typically involves ordering X-rays, but the specialist may need to order advanced imaging such as CT or MRI scans in order to evaluate more subtle Lisfranc injuries and determine the possible need for surgical consultation.
How do specialists treat a Lisfranc Injury?
In some cases, patients may not require surgery if the bones or ligaments have not completely fractured or torn. For some mild Lisfranc injuries, patients may return home wearing a cast or boot. Patients typically remain in the boot for 6 weeks to ensure a full recovery.
When it comes to surgical treatment, orthopedic foot and ankle specialists have a couple options depending on the case.
Open reduction internal fixation: In an ORIF procedure, surgeons start by making their incision on the top side of the foot and manually adjusts the broken bones back to their proper positions. Then they use hardware such as medical screws to fasten the bones together. Since the implanted hardware fastens together joints that usually have a range of motion, the physician may schedule a later date for patients to come back and have some or all of this hardware removed. This of course depends on the materials used and the surgeon. Most follow-up cases of hardware removal tend to happen around 3 to 5 months after the initial surgery.
Midfoot fusion: For certain patients with particular Lisfranc injuries, the proper treatment may involve a fusion of the injured bones. Ideally, an operation to fuse the midfoot will help realign the fractured bones so that they heal together in a way that removes the joint between them. Since the midfoot joints have a much smaller range of motion already compared to other joints in the body, a fusion can offer a great deal of pain relief without sacrificing function in the foot.
To perform a midfoot fusion, surgeons remove the cartilage from the ends of the bones and use metal hardware to push the bones together in such a way that they heal together. As opposed to an ORIF procedure, surgeons typically won’t remove the hardware in a midfoot fusion since the joints will not move after the operation.